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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: December 15, 2021 <br />Name: Finnian Cavanaugh Department of Public Works – Engineering Division <br />BPW Date: December 21, 2021 <br />Phone Extension: 5961 or <br />fcavanau@southbendin.gov <br /> <br />Required Prior to Submittal to Board BPW Attorney X Attorney Name Clara McDaniels <br />Dept. Attorney Attorney Name <br /> <br />Purchasing <br />Check the Appropriate Item Type – Required for All Submissions <br /> Professional Services Agreement Contract Proposal <br /> Open Market Contract Amendment/Addendum Special Purchase, QPA <br /> Bid Opening Bid Award Req. to Advertise Title Sheet <br /> Quote Opening Quote Award Reject Bids/Quotes <br /> Proposal Opening C/O & PCA No. PCA <br /> Chg. Order, No. 1 Traffic Control Resolution <br /> Other: Ease./Encroach <br />Required Information <br />Company or Vendor Name The Robert Henry Corp <br />New Vendor Yes If Yes, Approved by Purchasing <br /> No <br />MBE/WBE Contractor MBE <br /> WBE Completed E-Verify Form Attached Yes <br /> No <br />Project Name 100 S Michigan Tree Grates <br />Project Number 121-037 <br />Funding Source PO-0013007 (TIF River West & Motor Vehicle Highway) <br />Account No. 202-06-602-505-431000--PROJ00000288 <br />Amount $2,200 additional <br />Terms of Contract NTE <br />Purpose/Description Addition to cover removal of unforeseen buried concrete debris, <br />making room for tree plantings <br />For Change Orders Only <br />Amount of <br /> <br />Increase <br />Decrease <br />$2,200.00 <br />($ ) <br />Previous Amount $ 75,724.00 <br />Current Percent of Change: <br />Increase <br />Decrease <br />2.91% <br />( %) <br /> New Amount $ 77,924.00 <br />Total Percent of Change: <br />Increase <br />Decrease <br />2.91% <br />( %) <br /> Time Extension Amount: None <br />New Completion Date: 4/1/2022 (unchanged) <br />